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胸锁关节化脓性关节炎:一例报告

Sternoclavicular Septic Arthritis: A Case Report.

作者信息

Cydylo Michael, Ivanov Ivan, Chineme Jessica

机构信息

Emergency Department, New York City Health and Hospitals - South Brooklyn Health, Brooklyn, USA.

出版信息

Cureus. 2023 Apr 25;15(4):e38130. doi: 10.7759/cureus.38130. eCollection 2023 Apr.

Abstract

We report a case of a 47-year-old male who presented with concerns for a "mass" on the right side of his chest and low-grade fevers for the last month. The patient was found to have an induration, erythema, and warmth at the right sternoclavicular joint, with tenderness to palpation and pain in the movement of the right arm. The patient was found to have septic arthritis of the sternoclavicular joint based on CT imaging. Sternoclavicular joint septic arthritis is a rare diagnosis and accounts for very few diagnosed septic joints. Most patients have some sort of risk factors, such as diabetes, immunosuppression, rheumatoid arthritis, or intravenous drug use. The most common pathogen is . Our patient did not consent to joint aspiration for a definitive diagnosis of the causative organism and was therefore empirically treated for with trimethoprim-sulfamethoxazole. The patient also did not consent to any surgical management. Septic arthritis has been successfully treated with antibiotic therapy alone in the past, and in conjunction with the patient's choices, this was the treatment plan that was chosen for the patient. The patient responded to antibiotic therapy and followed up with a thoracic surgery clinic outpatient. This case depicts the importance of retaining a high index of suspicion for a rare diagnosis in the emergency department (ED). This case also depicts the successful treatment of sternoclavicular septic arthritis with outpatient oral trimethoprim-sulfamethoxazole, which, to the best of our knowledge, has not been done previously.

摘要

我们报告一例47岁男性病例,该患者因右侧胸部“肿块”及近一个月的低热前来就诊。患者右侧胸锁关节处有硬结、红斑及皮温升高,触诊时有压痛,右臂活动时疼痛。根据CT影像,该患者被诊断为胸锁关节化脓性关节炎。胸锁关节化脓性关节炎是一种罕见的诊断,在所有确诊的化脓性关节中占比极少。大多数患者有某种危险因素,如糖尿病、免疫抑制、类风湿关节炎或静脉药物使用史。最常见的病原体是……我们的患者不同意进行关节穿刺以明确致病微生物,因此经验性地给予复方新诺明治疗。患者也不同意任何手术治疗。过去,单独使用抗生素治疗化脓性关节炎已取得成功,结合患者的选择,这就是为该患者选择的治疗方案。患者对抗生素治疗有反应,并在胸外科门诊进行了随访。该病例体现了在急诊科对罕见诊断保持高度怀疑指数的重要性。该病例还展示了门诊口服复方新诺明成功治疗胸锁关节化脓性关节炎的情况,据我们所知,此前尚未有过这样的报道。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d995/10212690/3caafbcc07cd/cureus-0015-00000038130-i01.jpg

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